Abstract TP51: Improving Prescriptions of Cardiovascular-Effective Anti-Diabetic Medications in Patients With Stroke and Type 2 Diabetes

Abstract

Background and Issue: Type 2 diabetes (DM2) and cardiovascular (CV) disease pose significant risks for ischemic stroke, with a heightened impact on marginalized and under-resourced communities. Despite known CV benefits of newer anti-diabetic medications like glucagonlike peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose co-transporter-2 (SGLT2) inhibitors, these medications are under prescribed. To improve utilization, we conducted a quality improvement (QI) project to enhance prescription rates for these medications. The QI initiative focused on improving diabetes education and ensuring appropriate hypoglycemic medications were provided at discharge, with an aim of reducing the incidence of recurrent strokes. Purpose: The goal of this QI initiative was to improve prescription rates of GLP-1 R or SGLT2 inhibitors in eligible patients with stroke. Method: An assessment of current diabetic referral practices and medical therapy management were conducted, and an algorithm aimed at streamlining referrals for diabetic consults for patients with stroke developed. A diabetic educator or advanced practice nurse was consulted for patients with stroke and elevated A1c. Patients were then evaluated for qualification and use of GLP-1 RA or SGLT2 inhibitors, and discharge recommendations provided. A stroke registry was used to conduct a retrospective analysis of cases with stroke and DM2 for discharged prescriptions of GLP-1 R or SGLT2 inhibitors. Pre-implementation data from October 2021 to March 2022 were compared to post-implementation data from October 2022 to March 2023. Results: A review of 273 cases was completed. Prior to the QI implementation, 14.2% (19 of 134) of cases admitted for stroke with a secondary diagnosis of DM2 and elevated A1c were discharged home on a GLP-1 RA or SGLT2 inhibitor compared with 28.8% (40 of 139) of cases post implementation. Conclusion: Implementation of a QI process aimed at increasing the number of written discharge prescriptions for DM2 medications with proven CV benefits demonstrated a substantial increase in the number of written prescriptions for these medications at discharge.